Fertility News

Surgeons transplant a testicle from one brother to his twin

Surgeons transplant a testicle from one brother to his twin

A 36-year-old man born without testicles received one transplanted from his identical twin brother in a six-hour operation performed in Belgrade, Serbia, by an international team of surgeons, according to a New York Times report.

The surgery was intended to give the recipient more stable levels of the male hormone testosterone than injections could provide, to make his genitals more natural and more comfortable, and to enable him to father children, said Dr. Dicken Ko, a transplant surgeon and urology professor at Tufts University School of Medicine in Boston, who flew to Belgrade to help with the procedure.

The operation was only the third known transplant of this type. The first two were performed 40 years ago in St. Louis, also for identical twins, each pair with a brother lacking testicles.

The absence of testicles is an exceedingly rare condition, but doctors say that the surgery may have broader applications for transgender people, accident victims, wounded soldiers and cancer patients. But the procedure raises questions about the ethics of transplants that are not lifesaving, and about the possibility of recipients’ someday fathering children with sperm from donors who may not even be related to them.

The surgery was performed at the University Children’s Clinic in Tirsova, a section of Belgrade. The Serbian brothers are doing well, doctors said. Τhe recipient already has normal testosterone levels.

He’s good, he looks good, his brother looks good,” Dr. Ko said in a telephone interview on Friday. The donor, who already has children, should remain as fertile as he was before, despite giving up a testicle.

Because the patients are identical twins with the same genetic makeup, there is no concern that the recipient’s body will reject the transplant, so he does not have to take the immune-suppressing drugs that most transplant patients need.

Surgeons operated on the brothers simultaneously, in adjoining rooms. The procedure was challenging because it required sewing together two arteries and two veins that were less than 2 millimeters wide.

Once you remove the testicle from the donor, the clock starts ticking very fast,” said Dr. Branko Bojovic, an expert in microsurgery at Harvard Medical School and part of the team in Belgrade.

Within two to four hours, you have to have it re-perfused and working again,” Dr. Bojovic said. Without a blood supply, a testicle is viable for only four to six hours.

It can take 30 to 60 minutes to make each of the four blood-vessel connections. But the team managed to complete them all in less than two hours, he said.

The team did not connect a structure called the vas deferens, which carries sperm out of the testicles. The surgeons could not find the tissue in the recipient needed for the connection, which means that for now, he cannot father children in the usual way.

Another operation to make the connection may be possible. Otherwise, if the recipient wants children, he might undergo a procedure to extract sperm from the testicle for in vitro fertilization. Or his twin brother’s sperm could be used.

Dr. Ko and Dr. Bojovic were both part of the surgical team that performed the first penis transplant in the United States, in 2016, on a man whose penis had been removed because of cancer.

Dr. Miroslav Djordjevic, who led the team in Belgrade, specializes in urologic reconstruction and sex reassignment surgery at Mount Sinai Hospital in New York and at the University of Belgrade. He said the brothers approached him after learning that he had performed a successful uterus transplant between twins sisters, which enabled the recipient to give birth.

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Perimenopause’s negative impact on sexual function

Perimenopause’s negative impact on sexual function

A new study by Italian investigators points to a link between perimenopause and sharp decline in sexual function. The results, published in Menopause, show that vaginal atrophy—a treatable condition—is the factor that has the most impact on the negative trend.

The cross-sectional study enrolled 518 women aged 40 to 55 years at 30 centers across Italy. The authors analyzed relationships between vaginal atrophy and symptoms associated with it and the Female Sexual Function Index (FSFI) score, which is composed of 19 questions around the domains of desire, arousal, orgasm dyspareunia, lubrication, and sexual satisfaction.

Vaginal atrophy was defined as presence of a pH > 5, subjective vaginal dryness, and an objective sign, as assessed by a medical doctor. Mucosal pallor and dryness, thinning of vaginal rugae, mucosal fragility, and presence of petechiae were the signs considered.

Overall, 70.6% of participants had sexual dysfunction, as defined by a FSFI score < 26.55. It was seen in 55% of those aged 40 to 45, compared with 82.8% of those aged 52 to 55 (P < 0.01). From 48 to 51 versus 46 to 48 years, mean FSFI score and sexual dysfunction increased: 23.13 ± 9.76 vs. 19.49 ± 9.88; P < 0.05). A similar trend was seen from ages 48 to 51 vs. 52 to 55: 21.3 ± 8.06 to 17.59 ± 9.11; P < 0.01).

Age, weight, ex-smoking status, sedentary lifestyle, menopausal status, subjective vaginal dryness, dyspareunia, and vaginal atrophy were all inversely related to a woman’s FSFI score. Age, vaginal atrophy, and presence of vaginal dryness were all independent determinants of FSFI (R2 02.08; P = 0.011). The score was independently correlated (R2 0.116) with weight (CR -0.067; 95% confidence interval [CI] -0.126, -0.006; P < 0.032), menopausal status (CR -2.406; 95% CI -4.180, -0.63; P < 0.008), and vaginal dryness (CR -5.647; 95% CI -7.677, -3.618; P < 0.0001).

The only variable that correlated independently with each FSFI domain—including desire, arousal, lubrication, orgasm, satisfaction, and dyspareunia—was vaginal atrophy. The authors concluded that it is the symptom most closely related to all domains of female sexuality. They believe that prospective studies are needed to determine whether selective treatment of vaginal dryness improves female sexual function in perimenopausal women.

Said North American Menopause Society Medical Director Dr. Stephanie Faubion in a press release, “Given the high prevalence of sexual dysfunction in women, identifying an eminently treatable contributing factor such as vaginal dryness may allow women to maintain their sexual function during the menopause transition.”

Read more: https://journals.lww.com/menopausejournal/Citation/publishahead/Female_sexuality_and_vaginal_health_across_the.97274.aspx

Source: https://www.contemporaryobgyn.net/sexual-dysfunction/perimenopauses-negative-impact-sexual-function

New discovery may help women pause biological clock

New discovery may help women pause biological clock

From the moment a girl reaches puberty, her eggs begin maturing and gradually losing quality.

Genetic researchers at the Hebrew University of Jerusalem helped discover a biological switch that delays egg aging without losing egg quality – in worms.

They’re hopeful this breakthrough may lead to a way for women to extend their fertility windows and maintain high egg quality into their 30s and 40s.

Hebrew University scientists Yonatan Tzur and Hanna Achache, along with Tzur’s lab team and an associate at Harvard Medical School, studied egg maturation in C. elegans (roundworms) and published their findings in the scientific journal Genetics.

They chose these tiny worms because they have been helpful in shedding light on human genetics. Roundworms contain the same number of genes as humans do and their eggs mature in about one day.

Tzur and his team monitored the changes in each of the worm’s 20,000 genes during egg formation and were able to pinpoint an exact gene (ogr-2) that controls the rhythm of egg maturation. Delving further, the team studied MAP Kinase (“MAPK”), the biochemical switch that turns egg development on and off.

When they removed the ogr-2 gene with CRISPR gene-editing technology, MAPK went into overdrive and the worms’ eggs aged very quickly.

“We tested the gene’s role by removing it from the worm’s gene sequence. Instantly, these ‘edited’ worms became less fertile and their eggs more closely resembled those of an older worm,” said Tzur.

These findings are significant because aging egg cells are the main cause of birth defects, miscarriages and infertility. As human eggs age, abnormalities develop.

While in-vitro fertilization (IVF) allows doctors to select the best eggs, women above the age of 35 have less chance of producing a healthy baby with their own eggs. For women 42 and older, those chances are close to zero.

These statistics, along with the fact that the average age of first-time mothers in the Western world is increasing sharply, means finding the key to slowing down egg maturation is crucial and has spurred scientists like Tzur to discover the mechanisms that control ovarian development and oocyte aging.

Though still in its early stages, the discovery could have two possible applications for humans. One is to gently increase the equivalent of ogr-2 in girls via a food additive. This may allow girls to maintain the high quality of young eggs until they’re ready to use them.

Another potential tactic would be to suppress MAPK during IVF cycles. This would help older eggs complete their development and improve women’s chances of having a healthy baby as they get older.

Source: https://www.israel21c.org/new-discovery-could-help-women-pause-the-biological-clock/

New technique isolates placental cells for non-invasive genetic testing

New technique isolates placental cells for non-invasive genetic testing

A simple method for isolating placental cells from cervical swabs has been developed by Brown University researchers. The technique, described in the journal Scientific Reports, could aid in developing less invasive ways of diagnosing genetic disorders in developing fetuses, without using needles to harvest cells from the placenta.

The technique isolates trophoblast cells -placental cells that carry the complete fetal genome- by taking advantage of their tendency to settle to the bottom of microwell plates. The researchers lay out a procedure for optimally isolating the cells, enabling them to be picked individually from the plate.

“This is the first study to use cell settling for enriching trophoblast cells from a heterogeneous cervical cell population,” the researchers write. “Ultimately, we provide a technique that is quick, inexpensive, minimizes cell loss, and results in retrieval of individual trophoblast cells.”

The work was led by the lab of Anubhav Tripathi, a biomedical engineering lab at Brown that specializes in lab-on-a-chip diagnostics, in collaboration with the Shukla Lab for Designer Biomaterials at Brown’s School of Engineering, led by Anita Shukla, and with PerkinElmer, Inc.

Currently, the only way to diagnose genetic disorders in developing fetuses is by retrieving trophoblasts through amniocentesis or chorionic villus sampling, both invasive procedures that carry a small risk of miscarriage. Blood tests that look for fetal genetic material in the mother’s bloodstream can be useful screening tools, but they can’t be used for definitive diagnosis. And screening is limited to whatever genetic material happens to turn up in the blood, which limits the range of disorders that can be screened.

Trophoblasts are known to be present in the cervical canal in the early stages of pregnancy, but the quantities are small, and isolating those cells from cervical cells and mucus is difficult.

The researchers found that trophoblasts are smaller than cervical cells, differ in shape and have relatively large nuclei. Those characteristics suggested that they may settle more quickly than cervical cells when cell mixtures are placed on microwell plates.

Using polystyrene plates, the researchers found that the trophoblasts did indeed settle more quickly than cervical cells. The study showed that the maximum separation of cell types was achieved around four minutes after the cells were put on the plate. At that point, the cervical cells and mucus on top of the cells could be removed, leaving a large concentration of trophoblasts behind. The technique increased the proportion of trophoblasts in samples by 700%, enabling individual trophoblasts to be picked out for genetic testing.

No specialized equipment beyond what any diagnostic lab would already have is required to perform the technique, the researchers say. And takes only a few minutes to produce the cells necessary for genetic testing.

“There is a large need for biomedical engineering techniques toward advancing prenatal and women’s health. Our work is a step toward more non-invasive prenatal testing options”, the researchers said.

Read more:

https://www.nature.com/articles/s41598-019-48346-3

Source: https://www.brown.edu/news/2019-08-26/trophoblasts

French National Assembly approves IVF for lesbians, single women

French National Assembly approves IVF for lesbians, single women

France’s lower house of parliament overwhelmingly passed a bill that aims to give single women and lesbian couples legal access to in vitro fertilization, egg freezing and fertility medication.

The assisted reproduction measures are part of a broader bioethics bill voted by the National Assembly, the lower house, where French President Emmanuel Macron’s government has a majority. The bill passed 359-114. It must still go to the Senate for debate.

The new legislation will mean that two bioethical cornerstones of former French ART regulation – a diagnosis of infertility and the requirement of marriage or partnership – will now be removed in favour of a more liberal framework for treatment. Thus, single and lesbian women will be eligible for sperm donation or even IVF treatment.

The new legislation will also mean that ‘fertile’ women will now be able to freeze their eggs for later use as some kind of biological insurance against age-related infertility.

France’s health care system would cover the cost of the assisted reproduction procedures for all women under 43.

French law currently allows in vitro fertilization and related procedures only for infertile heterosexual couples. Many ineligible French women travel abroad to undergo IVF treatment.

Lesbian couples, single women or both already have legal access to medically assisted reproduction in 18 of the European Union’s 28 countries.

France’s pending legislation also would allow children conceived with donated sperm to find out the donor’s identity upon demand when they reach age 18, a change from France’s current strict donor anonymity protections.

The legislation does not address surrogate motherhood arrangements, which are banned in France.

‘This new law responds to a societal demand,’ health minister Agnès Buzyn told Le Parisien newspaper. ‘Family patterns have changed. All the studies now show that children raised in homosexual couples or by single mothers do not have any particular problems as distinct from children raised in more traditional types of family situations.’

Chlamydia in testicular tissue linked to male infertility

Chlamydia in testicular tissue linked to male infertility

The potential impact of undiagnosed sexually transmitted chlamydia infection on men’s fertility has been highlighted in a study led by Queensland University of Technology (QUT).

Researchers for the first time found chlamydia in the testicular tissue biopsies of infertile men, whose infertility had no identified cause.

The researchers also found antibodies specific to the bacteria responsible, Chlamydia trachomatis, in the blood of 12 of 18 donors of the fresh testicular biopsies, indicating the men had been exposed to the bacteria. Yet none of the men reported symptoms of infection or being previously diagnosed with chlamydia or any other sexually transmitted infection (STI).

The study, in collaboration with Monash IVF Group, Hudson Institute of Medical Research, Monash Health, and Queensland Fertility Group, has been published in the journal Human Reproduction.

Key findings:

Men whose tissue was tested were moderately to severely infertile, producing no or little sperm, and the majority had no defined cause of their infertility.

Chlamydia was found in 45.3 per cent of fixed testicular biopsies (43 of 95 men), obtained from the Monash Health Anatomical Pathology Department. All men in this group had no defined cause of infertility.

Chlamydia was also found in 16.7 per cent of fresh testicular biopsies (3 of 18 men), obtained during patient sperm recovery procedures by the Monash IVF Group and Queensland Fertility Group. These 3 men, and another 10 in the group, had no identified cause for their infertility.

In 12 of the 18 men providing the fresh biopsies (66.7 per cent) Chlamydia trachomatis-specific antibodies were found in serum, indicating the men had been exposed to the bacteria — but all were asymptomatic and said they’d not been diagnosed with any STI.

Research leader QUT Professor of Immunology Ken Beagley, from the Institute of Health and Biomedical Innovation, said chlamydia infection in men has not been as widely studied as it has in women, despite similar infection rates.

“Chlamydia infection has been associated with women’s infertility but much less is known about its impact on male infertility, particularly if men do not experience symptoms, which is estimated to be in about 50 per cent of cases,” he said.

“When people have no symptoms they can unknowingly pass on the infection to sexual partners.

“This is the first reported evidence of chlamydia infection in human testicular tissue, and while it can’t be said that chlamydia was the cause of the infertility of the men, it is a significant finding.

“It reveals a high rate of previously unrecognised chlamydia infection and the potential role of infection in the failure of sperm to develop in the testes.

“Animal studies by our group support these human findings. Those studies show that chlamydia infection in male mice establishes a chronic infection in the testes that significantly impairs normal sperm development.

Professor Beagley said testing testicular tissue could also be a useful future screening and diagnostic tool for clinicians and help inform them about treatments to improve reproductive outcomes.

“Normally a diagnosis of chlamydia infection is performed with a urine sample, but this may not always pick up the infection in men,” he said.

“In our study, two of the three patients whose fresh biopsies were positive for chlamydia were urine-negative for the bacteria. For the third patient we weren’t able to obtain a urine result.

“It indicates that infection may not shed into the urinary system, or do so only intermittently.”

Monash IVF Group male fertility specialist and study co-author, Professor Robert McLachlan, said for the majority of men with poor quality sperm, a cause is not apparent.

“We know certain contributors, like the toxic effect of chemotherapy drugs, but for many men there is nothing remarkable in their sexual or medical history that could account for their fertility issues,” he said.

Read more: https://academic.oup.com/humrep/advance-article/doi/10.1093/humrep/dez169/5580920

Source: https://www.sciencedaily.com/releases/2019/10/191009093946.htm

Twin births are dropping

Twin births are dropping

Demographers credit the boom in twin births since the 1980s to women choosing to become mothers at older ages, using fertility treatments to get pregnant.

The twin birthrate has declined in the United States after rising for three decades. A new report released by the National Center for Health Statistics shows that the twin birthrate fell 4 percent from 2014 to 2018, from 33.9 per 1,000 total births to 32.6 per 1,000 total births after years of increases.

The NCHS paper shows that the number of twin births, which more than doubled from 68,339 in the 1980s to a peak of 138,961 in 2007, declined to 123,536 in 2018.

Starting in 1980, the twin birthrate of 18.9 per 1,000 total births rose an average of 2 percent annually through 2003. The pace then slowed down to less than 1 percent annually through 2014. The recent decline was most sharp in women ages 30 and over. For those ages 30-34, it fell 10 percent. For ages 35-39, 23 percent. And for women ages 40 and over by 23 percent.

The twin birthrate was essentially the same for women in their 20s, according to the report.

One theory researchers put forward to explain the change is that fertility therapies, that previously involved transfers of multiple embryos, are less common.

In the mid-1990s, transfers of single embryos accounted for only about 5 percent of such procedures in the United States. Preliminary data for 2017 showed that more than 60 percent of transfers happened with just one embryo.

The decline in the twin birthrates was detected in older mothers and non-Hispanic white mothers. We know one of the largest factors influencing the rise in previous years was their use of fertility-enhancing therapies. They are the most likely to use those therapies”, said the report’s lead author, Joyce A. Martin, a statistician with the N.C.H.S. “Since the decline was limited to those two groups, it does suggest some changes might be happening,” Ms. Martin said.

In the past, many fertility doctors transferred multiple embryos during in vitro fertilization to increase the chances that at least one would implant successfully. More than a few of those pregnancies resulted in twins or higher-order multiples. But now many procedures transfer only one at a time. Many clinicians also advocate using lower doses of ovulation-stimulating hormones than in the past to avoid possible side effects.

Older women accounted for 20.5 percent of all births in 2014, but for 25.3 percent of all births in 2018. It is among these older women that the twin rates have diminished the most.

Read more: https://www.cdc.gov/nchs/products/databriefs/db351.htm#section_1

Sources:

https://www.washingtonpost.com/health/2019/10/03/is-twin-boom-ending/

https://www.nytimes.com/2019/10/04/health/twins-birth-rate.html

Pioneering treatment for chronic bacterial vaginosis

Pioneering treatment for chronic bacterial vaginosis

Researchers in Israel have revealed a groundbreaking therapy for chronic bacterial vaginosis (BV) using transplanted vaginal fluid from a healthy donor.

Published in the journal Nature Medicine, the study is the first to show the effectiveness of vaginal microbiome transplantation (VMT) to treat BV.

The study on five women between ages 27 and 47 was led by senior OB/GYN Ahinoam Lev-Sagie, an expert in vulvovaginal disorders at Hadassah-Hebrew University Medical Center in Jerusalem, in collaboration with leading microbiome expert Prof. Eran Elinav from the Weizmann Institute of Science in Rehovot.

Four of the five women went into full long-term remission after one to three VMT procedures, necessitating a change of donor in one patient, with no side effects. The fifth woman showed partial improvement.

The results were immediate,” Lev-Sagie said “and the change seen in the microbiome is tremendously impressive.”

VMT was the brainchild of Hadassah-Hebrew University Medical Center molecular biology researcher Debra Goldman-Wohl, one of the study’s lead authors.

She theorized that if fecal transplants can normalize an unbalanced gut microbiome (bacteria residing in the intestines), vaginal fluid transplants could normalize an unbalanced vaginal microbiome.

Elinav said the success of the “friendly microbiome takeover” experiment could lead to “an affordable solution for the very many millions of women across the world that suffer with this disorder.”

BV impacts around a third to one half of all women worldwide, with a subset of at least 4.4% of all women suffering of a severe intractable form of this disease, says Lev-Sagie.

The resulting change in the vaginal bacterial microbiome leads to unpleasant symptoms and a risk of fertility problems, pregnancy-related complications, early birth and other obstetric and gynecological complications.

At the severe end of the BV spectrum, antibiotic treatment is associated with very high relapse rates of up to 70 percent within one year after treatment. This leads to dependency on frequent or maintenance antibiotics use, or non-responsiveness altogether,” Lev-Sagie says.

Randomized, placebo-controlled clinical trials are planned to further determine the therapeutic efficacy of VMT in women with chronic bacterial vaginosis.

Source: https://www.israel21c.org/pioneering-treatment-for-chronic-bacterial-vaginosis/

Period Problems: what is causing them?

Period Problems: what is causing them?

By I.Soussis, MD, Fertility Specialist 

A woman experiences her period for the whole of her reproductive life. Sometimes, she considers as normal symptoms that should not exist.

Ηow do you know if your period is causing problems that it shouldn’t?

In most cases you should not worry if you:

  • get cramps

  • have low back pain

  • feel fatigue or discomfort

You should talk to your doctor if:

  • the pain is so bad you miss days of work or school every month

  • have such heavy bleeding that is causing anemia

These are things that may need investigation.

Most women’s menstrual cycles range between 21 to 35 days, or up to 45 days for teens. A recent study of 600.000 cycles from Britain, showed that only 13% of women have what we consider a “normal” cycle of 28 days. Bleeding usually lasts between three to seven days. What’s normal for one woman may not be for another.

The most common menstrual irregularities are:

  • not having a period at all

  • irregular periods

  • prolonged of shord periods

  • severely painful cramps

These problems can have many different causes, including:

  • scarring, caused by endometriosis or previous operations

  • hormonal imbalances (polycystic ovarian syndrome)

  • certain diseases or conditions (eg coagulation disorders)

  • medications (eg regular use of aspirin)

Uterine fibroids and endometriosis are two common causes.

Fibroids

Fibroids are benign tumors, made of muscle or connective tissue cells that grow inside or outside of the wall of the womb. Although the majority of women have at least one fibroid during their lives, most of them don’t have symptoms.

Very heavy bleeding during a woman’s period is the most common symptom of fibroids. Ultrasound is very good at diagnosing them.

Endometriosis

Endometriosis is caused by the lining of the uterus (endometrium) when it grows outside it, on other organs. The cardinal symptoms of endometriosis are period pain, pain during sex and infertility. Endometriosis probably accounts for at least a third of infertility in women.

Endometriosis diagnosis is very difficult. Currently, there is no blood test or imaging technique that can diagnose endometriosis. The only way to diagnose endometriosis is laparoscopy. This can lead to a delay in diagnosis, in part because no one wants to be quick to do surgery.

Both fibroids and endometriosis have familiar tendencies. Women may not know that severe pain or heavy bleeding aren’t normal. Sometimes the mother would advise the daughter to “put up with it, it’s normal for a woman”.

However, there are treatments that can improve your health and quality of life.

It is the duty of the doctor to advise appropriately and to offer the right treatment.

OB-GYNs hesitate to talk about fertility

OB-GYNs hesitate to talk about fertility

Many OB-GYNs are uncomfortable counseling their patients on fertility at a time when more women are delaying pregnancy and needing their doctors to be more vigilant about this education, according to a new study.

“We found that most OB-GYNs don’t bring up fertility with every patient, often because they believe the patient would bring it up if she wanted to discuss it,” said Rashmi Kudesia, M.D., reproductive endocrinology and infertility specialist at Houston Methodist and CCRM Houston and lead author on the study, published in the Journal of Reproductive Medicine. “It’s a missed opportunity when OB-GYNs don’t start the conversation because many women are routinely exposed to conflicting information about fertility, leading many to believe that they’ll have no issues conceiving and delivering.”

In fact, 82% of OB-GYNs surveyed believe women receive mixed messages about their optimal fertility window, and 68% said women seem to believe they can indefinitely postpone making childbearing plans.

“It isn’t unusual for women to believe that assisted reproductive technologies like IVF are their safety net because they hear so many success stories,” Kudesia said. “The reality is that IVF only has a 5% success rate for women in their mid-40s.”

Kudesia and her co-authors found that OB-GYNs were more likely to provide fertility counseling to married women between the ages of 27-40. For all age groups, single and lesbian women were less likely to receive fertility counseling than married women. It was also found that the 117 physicians who participated provided more counseling on contraception than fertility in nearly all age and relationship status groups.

“The results tell me that regardless of current relationship status or future plans for pregnancy, women need to bring up fertility at their next well-woman exam or ask for a referral to a fertility specialist,” Kudesia said. “Women who want to wait several years and even those who think they don’t want kids at all should still talk to their doctor about fertility so that they can make an informed decision about what is best for them.”

Source: https://www.houstonmethodist.org/newsroom/research-shows-ob-gyns-hesitate-to-talk-about-fertility/

Read more: http://www.reproductivemedicine.com/toc/auto_abstract.php?id=24782

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